Prenatal Care for You and Your Baby:

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1 : What to avoid during pregnancy, common problems, diet guidelines, travel, exercise, and more. We have assembled these basic guidelines to help with decisions about your health (and your baby's) during pregnancy. If you have any questions about these guidelines, please call the office at Please do not hesitate to call our office if you have any problems or questions! WHEN TO CALL THE OFFICE Call your doctor or nurse right away if you notice any of these symptoms: CONTRACTIONS that are timed ten minutes apart for at least an hour A gush or slow leaking watery fluid from the vagina. This usually indicates that there is a rupture in the membranes of the bag of water surrounding the baby. It is very important to call our office even if this is not accompanied by contractions Any vaginal bleeding is considered abnormal. Call our office immediately Decreased fetal movement If you have any of these symptoms, don't wait. Call your doctor's office at or go to the hospital. Estimated schedule of labs/sonograms that will be completed during your pregnancy: At each of your pre-natal visits you will be asked for a urine sample and your weight and blood pressure will be recorded. 15th - 19th Week: Quad Screen Blood Test 20th Week: Sonogram 27 Weeks, 1 Day: 1 Hour Glucose Test-CBC/Blood Test Weeks: CBC/STS/GBS Culture Prenatal Visits Schedule A complete medical examination will be done at the time of your first prenatal visit. At this time, a prenatal profile, blood test, urinalysis, and cervical culture will be obtained. It is very important that you make every effort to keep your scheduled appointments for your obstetrical care. *Your due date is determined based on your last menstrual period or first sonogram. Our physicians will want to see you on the following routine pre-natal visit schedule: 4-28 Weeks: Every 4 Weeks Weeks: Every 2 Weeks 36th Week - Delivery: Every Week

2 SYMPTOMS OF A MISCARRIAGE Active bleeding, passing of tissue or clots, or severe cramps are symptoms of miscarriage. If at any time you should have a sudden gush of water or leakage from the vagina, call the office immediately, even if there are no contractions. Obstetric Safe Medicine Information At some time during your pregnancy you may become sick with a common illness such as a cold, headache, nausea, vomiting or sore throat. When this happens, you may want to take an over the counter (non prescription) medication to make you more comfortable. It is best to use little or no medications during pregnancy, especially during the first three months. However, if you do choose to take medication, please review our list of safe medications to take during pregnancy so that you can make the best decision for you and your baby. If you ever have a question or are uncertain about taking a medication, even one prescribed by another doctor, please call (540) and speak with a nurse before taking the medication. Childbirth Education Classes For information on childbirth educations classes, please contact Texas Health Presbyterian Hospital Plano at , or visit our Texas Health Presbyterian Hospital Plano Childbirth Classes schedule and links to register. Morning Sickness Eat six to eight small meals per day. Do not skip meals. Keep two to three saltine crackers by your bedside at night and eat them before getting out of bed. A small snack before going to bed may also help. Antacids, Altoid mints, ginger tea, and lemon drops may help. The following recommendations are some things you can do in order to alleviate the discomfort of morning sickness. Eat several small meals daily as opposed to 3 large meals Eat dry crackers with juice before rising from bed in the morning. If You Do Not Drink Milk OsCal Calcium Supplement, non-prescription: take one tablet three times daily Tums - 2 per day Showers and Baths Showers and baths may be taken. However, you may not be in a hot tub that is over 100. Breast Secretions Breast secretions are normal during pregnancy. This commonly begins during the fourth month. Rest and Sleep Enough rest is imperative. Increased tiredness during the early part of your pregnancy should subside your 12th week. Dental Care Regular dental visits are encouraged. Be sure that the dental staff is aware of the pregnancy. There are certain precautions that must be taken during pregnancy Swelling Swelling in both legs is very common in pregnancy and will increase in hot weather, with prolonged standing and increased activity. Increase water intake to eight glasses per day and avoid adding salt to your food. Elevate your feet and legs above the level of your heart to improve circulation. Lie on your side when possible. Let your doctor know if you are experiencing swelling in the face or hands.

3 DIET GUIDELINES Weight Gain A weight gain of two or three pounds per month for a total of pounds is desirable if you are a normal weight. For women who are overweight, pounds is recommended. For women who are underweight, pounds is recommended. Protein Lean beef, chicken, and turkey (baked or broiled, not fried) are your best sources of protein. Fish Eat no more than four ounces (about one small serving) of tuna per week. Limit your total intake of tuna and cooked fish to twice a week. Avoid swordfish, shark, king mackerel and tilefish (also called golden or white snapper) as these can contain potentially risky levels of mercury. Listeria Listeria is a very rare infection, affecting less than 1 in 100,000 people in the United States per year. Listeria bacteria is found in uncooked meats, uncooked vegetables, un pasteurized milk, and processed foods. To prevent listeria exposure, avoid soft cheeses, such as feta, Brie, Camembert, blue veined cheese, and Mexican style cheeses such as queso fresco, queso blanco and Panela. Avoid hot dogs/luncheon meats/deli meats unless they have been properly reheated to steaming (or about 160 degrees F). Avoid refrigerated meat spreads and refrigerated smoked seafood. Canned meat spreads or canned smoked seafood are fine. Practice safe food handling. Any pasteurized dairy products, such as cream cheese, are fine. Iron Liver, peaches, grapes, dried apricots, raisins, egg yolks, fresh spinach, and peanut butter are rich in iron. An iron supplement will be recommended to you during your sixth month. Seasoning Onion, lemon, garlic and pepper are good choices. Avoid prepared salts like onion or garlic salt. Limit salt intake (hide your salt shaker!). Recommended Snacks Fresh fruits, fresh vegetables, hard-boiled eggs, raisins, baked turkey or chicken. Listeria Listeria is a very rare infection, affecting less than 1 in 100,000 people in the United States per year. Listeria bacteria is found in uncooked meats, uncooked vegetables, un pasteurized milk, and processed foods. To prevent listeria exposure, avoid soft cheeses, such as feta, Brie, Camembert, blue veined cheese, and Mexican style cheeses such as queso fresco, queso blanco and Panela. Avoid hot dogs/luncheon meats/deli meats unless they have been properly reheated to RH Negative Blood Type If you have the RH negative factor in your blood type, our office will monitor you closely with additional blood work throughout your pregnancy. If a Rhogam injection is needed your doctor/nurse will give more information. TRAVEL We do not recommend traveling during the first three months or the last three months of pregnancy. If you must travel, stop frequently, empty your bladder and walk. Travel to high altitudes may cause headaches, nausea, or shortness of breath until you become acclimated to the area.

4 COSMETIC TREATMENTS, HAIR COLORING, AND MASSAGE It is unknown if permanents, highlighting, manicures/pedicures and/or coloring of hair is harmful to pregnancy. If you choose to undergo these treatments, they need to be done in a well-ventilated area by skilled/licensed professionals. Pregnancy massage is usually safe if the therapist is licensed and equipped with a special table. SEXUAL ACTIVITY you may continue to have sexual intercourse throughout your pregnancy, unless you feel uncomfortable or your doctor advises you otherwise. EXERCISE We encourage you to maintain the same level of activity you had prior to pregnancy. However, avoid water skiing, any high impact sports, horseback riding, scuba diving, hot tubs and tanning beds. Pregnancy exercise videos may also be used.

5 SYMPTOM/CAUSE REMEDIES THINGS TO AVOID Backache - Caused by strain of increased uterine weight on back muscle, aggravated by poor posture. Good Posture, rest with weight off back, wear flat-heeled shoes, sleep on a firm mattress, try pelvic rock exercise Avoid high-heeled shoes, fatigue Bladder Infection - May be caused by a preexisting asymptomatic infection or by catheterization at delivery. Drink plenty of water and acidic fruit juices. Cranberry juice is best. Increase vitamin C. Strict attention to feminine hygiene, wear cotton underwear, and consult doctor if symptoms persist to avoid development into kidney infection. Avoid tight underwear or underwear that is made of synthetic non-breathing materials. Avoid drinking coffee or black tea. Avoid catheterization, if possible. Constipation - Progesterone relaxes smooth muscles of gut making it less effective, intestines compressed. Heartburn - Enlarging uterus presses on stomach, forcing stomach fluids back up into esophagus. Hemorrhoids - Pregnancy hormones relax smooth muscles of veins, causing vasocongestion, may be aggravated by straining over bowel movements. Insomnia - Often hard to sleep in the last months of pregnancy due to difficulty getting comfortable, frequency of urination, worries and fetal movements. Nausea - Possibly caused by hormonal changes and/or emotional factors. Increase roughage in diet, daily walk, increase water, eat prunes, raise feet on foot stool and relax pelvic floor when on the toilet. Increase your water intake to six to eight glasses per day. Increase bulk by eating more fiber, including bran cereals, fruits and raw vegetables. Stool softeners such as Colace, or fiber products like Citrucel, Fibercon, Konsyl, and Metamucil are permitted in pregnancy (no prescription is needed). Eat several small meals instead of three large ones, sit up straight, elevate ribcage, sleep with upper body propped up, and sip milk or tea. Elevate feet, relax pelvic floor, drink plenty of fluids, eat roughage assume knee chest position, apply cold compresses with witch hazel. Hot bath Hot bath, drink hot milk or soothing herb teas at bedtime, use relaxation techniques, exercise daily, increase vitamin B intake, use massage, avoid caffeine. Increase intake of vitamin B6, eat 4-6 small meals per day, drink peppermint teas, and snack on toast or crackers before getting up in the morning, noncaffeinated ginger ale helps as well. Avoid laxatives, mineral oil, and enemas. Avoid antacids; check with health care provider before use. Avoid greasy, spicy food, coffee and alcohol. Avoid straining and pushing too hard when having a bowel movement. Avoid developing constipation or diarrhea. Avoid sleeping pills and tranquilizers. Avoid chamomile tea if you are allergic to ragweed. Avoid cigarette smoking, greasy spicy food, and either an empty stomach or an over full stomach.

6 Shortness of Breath - Caused by pressure of enlarging uterus on diaphragm and lungs Maintain good posture; sit up straight, sleep with upper body propped up. Avoid Anemia Stop Smoking Avoid Over- Exertion Varicose Veins - Decreased efficiency of venous return from the leg aggravated by enlarging uterus. Elevate legs frequently, use support stockings, and walk daily. Avoid prolonged standing, avoid sitting with crossed legs, constrictive clothing or garters.